Oral manifestations of Celiac Disease

Summary:

Celiac disease is one of the most common GI disorders in the world. Approximately 1% of North Americans have been diagnosed with celiac. It has been suggested however that because of our previous lack of understanding of this condition and inability to accurately diagnose it, this number could be significantly higher (some suggest that 90% of cases of celiac remain undiagnosed). Celiac disease is a permanent intolerance to gluten (which is a protein in wheat/rye/barley) that results in a damage to the small intestinal mucosa caused by an autoimmune mechanism. The average duration of symptoms before diagnosis in adults in 11.7 years, although celiac can develop at any age.

Oral manifestations of Celiac Disease:

Enamel Defects:

If celiac appears in children while the permanent teeth are developing (prior to age 7) abnormalities in structure of the enamel can occur. This tends to appear symmetrically and chronologically in all 4 quadrants of the mouth. A band of hypoplastic (chalky white) enamel with intact cusps is common and both hypomineralization (poorly mineralized enamel) and hypoplasia (abnormally formed enamel) can occur. Enamel defects do not tend to be seen as frequently in adults diagnosed celiac disease as the enamel on their permanent teeth was fully formed prior to the manifestation of symptoms.

Dental Caries:

Several studies have demonstrated that there is no difference in the incidence of cavities between celiac patients and the general population. (although one study suggested that the propensity for cavities was slightly higher in celiac patients).

Recurrent Aphthous Ulcers:

16% of children and 26% of adults suffer from recurrent mouth ulcers. The cause of these ulcers is unknown, although there is likely hemanitic/hemoglobin deficiency, low serum iron, low folic acid, and low vitamin B12 due to malabsorption.

Role of the dentist/hygienist:

The mouth is the portal to the gut therefore a lot of physicians will look in the mouth as part of their exam. Physicians however seldom assess the teeth and as such dentists and hygienists can play an important role in screening for celiac disease. Patients suffering from recurrent aphthous ulcers and / or who manifest abnormalities in the formation of their enamel AND who struggle with gastrointestinal issues should be considered as possible celiac patients and should consult their physicians for further testing.

* Based on the article entitled: Oral Manifestations of Celiac Disease: A Clinical Guide for Dentists. H Limeback et al. JCDA. April 11, 2011.